Plais Nicolas, Garzón-Alfaro Adoración, Carrasco Jiménez Carlos José, Almagro Gil Maria Isabel, Jiménez-Herrero Enrique, Gómez Sánchez Rafael Carlos, Martín Roldán José Luis, Lafage Virginie, Schwab Frank
Orthopedic Surgery Department, Hospital Universitario San Cecilio.
University of Granada.
Clin Spine Surg. 2025 Jul 1;38(6):E358-E363. doi: 10.1097/BSD.0000000000001742. Epub 2024 Nov 25.
Cross-sectional study.
To assess the potential role of degenerative myelopathy as a risk factor for major fragility fractures in older patients.
Degenerative cervical myelopathy (DCM) stands as the foremost spinal disorder affecting adults, significantly impacting patients' quality of life. However, it is often underdiagnosed, with its prevalence traditionally considered low (0.06%-0.112%). Despite the rising prevalence of hip fractures with an aging population and the identification of numerous risk factors, DCM is not typically regarded as a primary risk factor for such fractures. In 2015, an American study revealed an unexpectedly high rate of 18% of undiagnosed DCM in patients with hip fractures within a small cohort. We sought to replicate this study in a larger cohort of a European population.
Our cross-sectional study targeted patients older than 65 years with hip fractures and aimed to identify cases of DCM at the time of fracture. Exclusions were made for patients with preexisting DCM diagnoses, neurological disorders, prior cervical surgeries, and instances of high-energy trauma. Comprehensive demographic, clinical, and radiologic data were collected, followed by descriptive and statistical analysis.
In our study, 147 patients (mean age: 82.9 y) were included. Through a combination of clinical assessment and physical examination, 23 patients (15.6%) were identified as indicative of myelopathy. Confirmation through magnetic resonance imaging led to an estimated overall prevalence of DCM at 10.5%. Logistic regression analysis revealed that the presence of hypertonic reflexes, cervical pain, or cervicobrachialgia were specific and valuable indicators for diagnosing myelopathy.
This study marks the first investigation of its kind in a European population, highlighting the notably high prevalence of undiagnosed DCM among older patients who have experienced hip fractures. This underscores DCM as a potential risk factor for hip fractures in the elderly, despite its underdiagnosis and undertreatment.
Level III.
横断面研究。
评估退行性脊髓病作为老年患者主要脆性骨折危险因素的潜在作用。
退行性颈椎脊髓病（DCM）是影响成年人的首要脊柱疾病，对患者的生活质量有重大影响。然而，它常常被漏诊，传统上认为其患病率较低（0.06%-0.112%）。尽管随着人口老龄化髋部骨折的患病率不断上升，且已确定了众多危险因素，但DCM通常不被视为此类骨折的主要危险因素。2015年，一项美国研究显示，在一个小队列中，髋部骨折患者中未诊断出的DCM发生率意外高达18%。我们试图在更大的欧洲人群队列中重复这项研究。
我们的横断面研究针对65岁以上髋部骨折患者，旨在在骨折时识别DCM病例。排除已有DCM诊断、神经系统疾病、既往颈椎手术以及高能创伤病例的患者。收集了全面的人口统计学、临床和放射学数据，随后进行描述性和统计分析。
我们的研究纳入了147例患者（平均年龄：82.9岁）。通过临床评估和体格检查相结合，23例患者（15.6%）被确定为有脊髓病指征。经磁共振成像确认，DCM的总体患病率估计为10.5%。逻辑回归分析显示，存在亢进反射、颈部疼痛或颈臂痛是诊断脊髓病的特异性且有价值的指标。
本研究是在欧洲人群中首次进行此类调查，突出了在经历髋部骨折的老年患者中未诊断出的DCM患病率显著较高。这强调了DCM尽管未得到充分诊断和治疗，但仍是老年人髋部骨折的潜在危险因素。
三级。
